Can smokers switch from a hospital-based to a community-based stop smoking service? an open-label, randomized trial comparing three referral schemes.

INTRODUCTION: Many hospitals advise their smoking patients to contact a community-based stop smoking service. We investigated how well smokers attend a community-based service after receiving help from a hospital smoking cessation specialist (HSCS). METHODS: In this 55-week, single-blinded trial, 450 consecutive smokers, attending two U.K. hospitals, were randomized. Group A received a brief intervention consisting of a 20-min consultation from an HSCS and leaflets with contact information for their community-based service. Group B received a 60-min consultation, four weekly appointments with the HSCS, and leaflets with contact information for their community-based service. Group C received a 60-min consultation and four weekly appointments with the HSCS and then agreed to attend a scheduled appointment at the nearest community-based service within 1 week. Pharmacotherapy was recommended to all participants, and they were advised to attend the community-based service for ongoing support immediately and at Weeks 5, 12, 26, and 52. At 55 weeks, the HSCS contacted participants again, without warning, for validation. RESULTS: Community-based service attendance at 5 weeks was 7% in Group A, 4% in Group B, and 23% in Group C (p < .001). Over 12-26 weeks, rates of community-based service attendance were 6%-12% in all groups. These rates remained consistently higher in Group C (p < .05) but fell throughout the period to only 3%, 5%, and 7%, respectively, at 52 weeks (p = .26). HSCS attendance at 55 weeks and point prevalence, validated quit rates were 17% for Group A, 20% for Group B, and 22% for Group C (p = .75). DISCUSSION: A specific appointment improves immediate and medium-term attendance at the community-based service, but hospitalized smokers do not switch well to a community-based service following any referral strategy. However, a significant proportion made a repeat visit to the hospital-based program much later on.

Prevalence of anxiety and depression in patients with severe COPD: similar high levels with and without LTOT.

The benefits of long-term oxygen therapy (LTOT) on mood in Chronic Obstructive Pulmonary Disease (COPD) are unproven. Longitudinal studies are affected by disease progression, the increased package of care (with LTOT) and may not control for known confounders on mood. We compared the point prevalence and severity of mood disturbance in patients with severe COPD, not on LTOT (the -LTOT group) to those with COPD on LTOT (the +LTOT group). We mailed the Hospital Anxiety and Depression (HAD) Score to 182 consecutive patients with severe COPD, identified from respiratory case notes in three UK Hospitals. We compared 57 patients not prescribed LTOT to 57 patients on LTOT, and used stratified sampling to match the groups as far as possible for age, gender, lung function and other possible confounders on mood. Or these, 25% of patients in both groups scored in the 'definite' case range for anxiety (HAD score >or= 11). 37% of the -LTOT group and 33% of the +LTOT group scored in the 'definite' range for depression (HAD score >or= 11) (p=N.S). In both groups, only 11% of responders were prescribed anxiolytics and/or antidepressants. Further multiregression analysis confirmed that socio-demographic variables (e.g., lives alone, feels isolated or recent life events) were stronger predictors of mood than the prescription of LTOT or other traditionally accepted factors such as co-morbidity or the use of antidepressants or anxiolytics. High levels of anxiety and depression are present in severe COPD and appear under-treated. The +LTOT and -LTOT patients had a similar high prevalence of anxiety and depression.

Facilitation of receptive and productive foreign vocabulary learning using the keyword method: the role of image quality.

Ellis and Beaton (1993a) reported that the keyword method of learning enhanced memory of foreign vocabulary items when receptive learning was measured. However, for productive learning, rote repetition was superior to the keyword method. The first two experiments reported here show that, in comparison with rote repetition, both receptive and productive learning can be enhanced by the keyword method, provided that the quality of the keyword images is adequate. In a third experiment using a subset of words from Ellis and Beaton (1993a), the finding they reported, that for productive learning rote repetition was superior to the keyword method, was reversed. The quality of keyword images will vary from study to study and any generalisation regarding the efficacy of the keyword method must take this into account.